Glucoma

Question 1

Why are beta blockers sometimes used in open angle glaucoma?

Answer 1

To reduce aqueous humour production

Question 2

What is the name of the drug used immediately in acute closed angle glucoma?

What is the MoA?

Answer 2

Pilocarpine

Muscarnic receptor agonist - constrict pupil -> increase iris -> increase aqueous outflow

Question 3

What is glucoma?

Answer 3

Problems with aqueous fluid drainage -> results in increase in IOP -> progressive neuropathy

Question 4

What are the two types of glucoma?

Describe their pathology.

Which is more sight-threatening?

Answer 4

Open-angled glucoma

• problem with the drainage at the trabecular network
• increase in pressure in anterior chamber

Closed angled glucoma (more sight-threatening)

• problem with outflow through the iris
• increase in pressure in the posterior chamber

Question 5

Compare closed and open angle glucoma in terms of the following factors:

• speed of onset
• symptomatic presentation?

If symptomatic what symptoms are present?

Answer 5

Open angle

• slow, insidious onset
• often asymptomatic

Closed angle

• acute presentation
• v.symptomatic
• extreme unilateral pain -> can cause intense headaches and vomiting
• red eye
• “haloes around light” (buzzword)
• mid-dilated pupil
• vision loss

Question 6

What sign is present on fundoscopy?

Answer 6

Cupping

Cup almost takes up whole of optic disc (due to increase in IOP)

Question 7

What constitutes intra-ocular HTN?

Answer 7

> 21mmHg

Question 8

What drug is used first line for open-angle glaucoma?

How does it work?

What is the common side effect?

Answer 8

Latanoprost

Increases the patency of the trabecular network -> increases aqueous outflow

Causes a darkening of the iris and increased eyelash growth

Question 9

What drug can precipitate acute closed angle glaucoma?

Answer 9

Mydiatric eye drops